Authorization for Use of Medical Information
Effective 05/03/25
Different Health WILL NOT sell your name or contact information to any third party. Foremost, we respect and honor your privacy.
Occasionally, Different Health may contact you about products and services that are relevant to you based on your health data. For example, if you receive lab test results that indicate an elevated heart risk, Different Health might send you an email about the benefits of an at-home heart monitor with a link to purchase – but we WOULD NOT disclose your name or contact info to the third party offering this monitor.
In order for Different Health to legally contact you about products and services that may be relevant and important for you, Different Health requires you to accept the form appearing below.
Authorization Details
I hereby authorize Different Health and its affiliates ("Different Health"), to use my medical information for the purposes listed below. Failing to provide all information requested may invalidate this Authorization.
My authorization applies to the following types of information: all of my individually identifiable medical information as received by Different Health, including my name, birthdate, contact information (such as e-mail, address, phone number), demographic information, and any other information pertaining to my medical history, mental or physical condition, or treatment.
The purpose of this Authorization is to permit Different Health to: use the information listed above in connection with marketing, advertising, and promotional activities by Different Health regarding:
(a) the release, availability, details, specifications, features, quality, performance, and/or price of one or more products, services, and/or opportunities offered by Different Health and/or a third party; and/or
(b) news, current events, research, history, and advances in science, health, wellness, nutrition, personal care, and/or technology that Different Health deems may be of interest to you.
SMS and Contact Policy
I agree that Different Health may contact me by SMS and text messages regarding marketing, advertising, and promotional activities, as described above, subject to the following terms and conditions.
I acknowledge that I can cancel the SMS service at any time by texting "STOP" to the short code; I understand that after I send an SMS message "STOP" to Different Health, Different Health will send me an SMS message to confirm that I have been unsubscribed, and I will no longer receive SMS messages from Different Health. If I want to receive SMS messages from Different Health again, I can sign up as I did the first time and Different Health will start sending me SMS messages again.
I acknowledge that, if I experience any issues with Different Health's messaging program, I can reply with the keyword HELP for more assistance, or I can get help directly at [email protected].
I agree that Carriers are not liable for any delayed or undelivered messages.
I acknowledge and agree that message frequency varies. I further acknowledge and agree that message and data rates may apply for any messages sent to me from Different Health and to Different Health from me. I acknowledge that it is best to contact my wireless provider with any questions about my text plan or data plan.
I acknowledge that I have been advised to review Different Health's Privacy Policy regarding any questions concerning the privacy of my data and information.
Legal Considerations
I understand that:
● Any use or disclosure carries the potential for unauthorized re-disclosure. Such redisclosure is in some cases not prohibited by state law and may no longer be protected.
● New York law prohibits the recipient of my medical information from making further disclosures unless the recipient obtains another authorization from me or unless such disclosure of medical information is required/permitted by law.
● I may revoke this Authorization at any time. My revocation must be in writing, signed by me or on my behalf, and delivered to Different Health at the address listed below.
● My revocation will be effective upon receipt, but will not be effective to the extent that Different Health or others have acted in reliance upon this Authorization.
● I have a right to receive a copy of this Authorization. I may inspect or obtain a copy of the medical information used or disclosed subject to this Authorization.
● Unless otherwise revoked by me, this Authorization shall be effective for five ( 5 ) years from the date of my approval.
● I have read and understand the above statements, and authorize the use of my medical information by Different Health as identified in this Authorization.
Contact Information
For questions, please contact Different Health:
Different Health
Visit us at: www.differenthealth.com
Email: [email protected]
